Thursday, June 16, 2011

Healthwatch Newsletter Update June 16th

The Assembly Starts Debate on the State Budget, Supreme Court Rules on Act 10!

June began with a political bang! Wisconsin's Joint Finance Committee finalized amendments to the state budget, preparing for debate in the full legislature. Rep. Jeff Fitzgerald announced that the legislature would be in an "extraordinary session" when hearing the budget, limiting amendment and debate in a move to expedite the passage of the bill. In the meantime, the Wisconsin Supreme Court, with unusual speed, reinstated the "Budget Repair Bill," or "Act 10," set to be effective law on June 29. Read more inside today's Update!

Wisconsin's Budget Timeline

Supreme Court Rules on Act 10

Wisconsin's Joint Finance Committee finished executive sessions on the state budget last week, leaving the fate of the document threatening the health care options of Wisconsin's middle-to-low income families in the hands of the state Legislature. After Joint Finance tweaked the Senate version of the budget bill, the full Assembly was the first to take up the state's fiscal budget document for the biennium, beginning its work on Tuesday, June 14. (The Assembly actually recessed at 10pm after waiting for amendments to come back from the drafters, deciding to begin budget debate Wednesday morning.) The Senate will take up the budget after the Assembly is done, expected to fall on Thursday, June 16. The entire process will be most likely completed in time for a July 1, 2011 effective date of the budget. On Tuesday, June 14, in an unprecedented move, the State Supreme Court's Majority decision was to overrule Judge Maryann Sumi and enact the changes of Act 10, also known as the "Budget Repair Bill" or "Collective Bargaining Bill."

See more on the Supreme Court Opinion below.Health Coverage Issues in the Budget:

The Status of Medicaid. The Joint Finance Committee followed Governor Walker's recommendation to cut more than $466.6 million from Medical Assistance. The details of the cuts are unknown, being identified as "various unspecified changes" in the budget papers. The Legislative Fiscal Bureau gave examples of what they thought the Medicaid cuts might look like, largely, increasing cost sharing, dropping higher income children from BadgerCare Plus, "bringing the coverage of working families back in line with employer-sponsored insurance," and making changes to eligibility criteria.

Power Shift to DHS: The budget gives legislative authority to unelcted leaders of the Department of Health Services to make changes to BadgerCare and Medicaid programs with very limited oversight and no public input. Joint Finance implemented a passive review process for future BadgerCare and Medicaid changes. This means that the budget committee, not the full legislature, will oversee future review processes. Joint Finance also repealed a budget repair bill provision that previously required DHS to go through normal rulemaking processes. The budget simply eliminates the requirement that the department hold any meetings and there is no requirement for publication of whatever changes DHS makes to the programs, including changes in benefits and eligibility for Medical Assistance programs. (See more in the "Analysis" section below.)

Behind the Curtain: How the Budget is Being Passed

Extaordinary Session. Republican Assembly leaders called for an “extraordinary session” on Tuesday, impacting how the state budget will be heard and voted on in both legislative houses. This move will limit debate and amendments. Under this “extraordinary session,” the Legislature is free to suspend most rules regarding bill notification, debate, and may consider the entire budget, as the purpose of the Session dictates. The Legislature may also expand the extraordinary session to whatever other business it chooses upon completion of the budget. The entire State Budget being taken up in extraordinary session is unprecedented. This type of session has only occurred six times since created in 1977. Assistant Assembly Minority Leader Donna Seidel (D-Wausau) commented, “It appears to be part of their strategy that anything can happen and anything can be rushed through with little or no scrutiny."

The Governor's Veto Power. Governor Walker can veto the entire budget, approve it, or use a partial veto power when the budget gets to his desk. Partial veto is different than line item veto power in that Governor Walker can veto individual words and phrases he does not like in the final budget. The power to cross out words is a long-standing right of the Wisconsin Governor for any bill that includes an appropriation--adopted in 1930 by amendment to the Wisconsin Constitution. No other state in the nation gives its governor this much discretion.

HealthWatch Public Hearings: The Human Impact of Medicaid/ BadgerCare Cuts in Wisconsin

HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.

Medicaid Infusions into States End June 30

It was just over two years ago when President Obama infused more than $90 billion of federal money into Medicaid. In just a few days, the money runs out, meaning cuts for millions of people, cuts to Medicaid payments to doctors and hspitals, reduced services, increased cost sharing and increased costs in other parts of the health care system. Patients will turn to the emergency rooms for care, spreading the expense and debt more widely.

In his June 15 article, "States Brace for End of Extra Payments for Medicaid," New York Times Columnist Robert Pear writes, "Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.

HIRSP Premiums to Increase July 1

First reported in Wisconsin Health News, the state's HIRSP Authority is said to be increasing premiums by 15%, effective July 1, 2011. The increase is necessitated by an almost 40% jump in medical expenses in recent months and a state law that requires HIRSP members to carry 60% of the plan costs. One of the key factors impacting plan costs is the increased prices of top-selling brand name drugs.

HIRSP sent a letter to its policyholders explaining the changes this month. In the meantime, if you have any questions, the general phone number for HIRSP is 1-800-828-4777.

What about the HIRSP "expansion" recently articulated by HHS Secretary Sebelius? The Department of Health and Human Services is making it easier for people to qualify for federal high risk pools, called Pre-existing Condition Insurance Plans (PCIP) and established by the federal government though health reform law...but only slightly easier. Applicants no longer need a letter of rejection to qualify, but can instead use a letter from their doctor indicating that they have an existing medical condition. In addition, the federally run PCIPs are lowering premiums based on a revised actuarial analysis. For the HIRSP plans in Wisconsin, the HIRSP authority has stated that the premiums are as low as they can be while still meeting the requirements in the federal law.

Enrolled in HIRSP and Seeking Care Out of State?

Summer vacations are upon us! For those people enrolled in Wisconsin's State Health Insurance Risk Sharing Plan (State HIRSP), individuals can have care services covered if they are outside the state of Wisconsin. A State HIRSP plan member can receive services outside of Wisconsin, however you may be responsible for some portion or some unpaid balance of the bill. In urgent/emergency care situations, both State HIRSP and Federal HIRSP plan members can receive services out-of-state, but they may also be balanced billed. Not able to pay the balance? In some instances, you can work with a HIRSP representative to negotiate with the hospital/service provider. You may also seek a charity care application to remove the balance of the bill.

Member Profile

Mimi Farber, Government Programs Counselor, UW Hospital and Clinics

Mimi helps connect uninsured and underinsured patients and families to state programs like BadgerCare Plus. She and fellow UW Hospital Government Programs Counselor Josh Salazar work closely with social workers, case managers and community resources to do so. Having worked at the hospital for the past eight years, Mimi recognizes and understands the hardship these patients and families are going through. “Having a family member in the hospital is often unexpected and very stressful,” she said. “Added to that is the financial burden of medical bills.”She evaluates a patient’s or family’s situation, finds out what programs they might be eligible for and assists them in the application process. Some of these patients are routed to Mimi through the hospital’s admissions department, which makes note of uninsured patients who check in, some walk in through outpatient care, and some are referrals from outside organizations.Although she and Josh have a steady queue of patients to help each day, the options for these patients are dwindling. “The shrinking options particularly evident this year have been extremely disheartening and challenging,” she said.As a Dane County HealthWatch Coalition and Steering Committee member, Mimi knows how important it is to stay educated and up-to-date on today’s rapidly changing policies, and to join like-minded individuals to protect our vital government health programs. “Joint advocacy is so important in these unfortunate times,” she said.Mimi uses her membership not only to attend meetings and conferences, but also to educate staff members at the hospital about state programs. “Not only do I assist patients and families, but also important is educating hospital staff in being knowledgeable about and creative with the programs in our toolbox,” she said. “HealthWatch is truly my lifeline.”Like many health care advocates in Wisconsin, Mimi is concerned about how the Walker administration’s budget and recently passed legislation will affect her clients. “It already has meant and will mean fewer options for access to health care,” she said. “Combined with the economy, it’s going to be very hard on people.”But despite these setbacks, Mimi remains resolute in her conviction to help patients and families get and maintain health coverage. “Connecting patients to resources is vital; maintaining their eligibility is also imperative,” she said. “Healthcare for all is a no-brainer.”

CKSN CornerCovering Kids with Special Needs

The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.

July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit maxishare.com.September 22. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 5:30-8:30 p.m. Topic: Parents and partners on a journey; public support systems avaialble to assist you and your child; private insurance and your provider. To register, call 877-568-5205 or email KVanVooren@chw.org.October 1. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 9 a.m.-noon. Topic: More about Medicaid; advocating for systems change. To register, call 877-568-5205 or email KVanVooren@chw.org.

State & National NewsAnalysis and Comment

Wisconsin Supreme Court Swoops In

Supreme Intervention. Initially, legislators wanted to add the elements of the March 2011 "Budget Repair Bill," also known as "the Collective Bargaining Bill" and "Act 10," back into the budget. HealthWatch Wisconsin tracked the Budget Repair Bill and the potential consequences for individuals and families on BadgerCare Plus and Medicaid programs in Wisconsin. Act 10 was in front of the state Supreme Court to determine if open meeting laws had been violated when the bill was quickly passed by conference committee. On Tuesday, June 14, in an unprecedented move, the State Supreme Court's Majority decision was to overrule Judge Maryann Sumi and enact the changes of Act 10. The process for the Secretary of State publishing Act 10 will most likely start today, June 15. The process for full publication usually takes the full 10-day statutory limit for doing so so the anticipated "effective date" of the law is June 29. For complete coverage of Act 10 through Tuesday's ruling, visit the Wheeler Report's Comprehensive website.

Unprecedented. Unusual speed. Hasty. Rash. The headlines this morning captured the unsettled feeling of many that the Wisconsin Supreme Court swooped in, issuing an alarmingly quick opinion on Wisconsin's Act 10, the "Collective Bargaining" or "Budget Repair Bill" that had been enjoined from implementation by Dane County Judge Maryann Sumi. In the majority opinion, the Court stated, “The court’s decision on the matter now presented is grounded in separation of powers principles,” the justices wrote. “It is not affected by the wisdom or lack thereof evidenced in the Act. Choices about what laws represent wise public policy for the State of Wisconsin are not within the constitutional purview of the courts. The court’s task in the action for original jurisdiction that we have granted is limited to determining whether the legislature employed a constitutionally violative process in the enactment of the Act. We conclude that the legislature did not violate the Wisconsin Constitution by the process it used.” Chief Justice Shirley Abrahamson critized the majority. As reported by WisPolitics, Justice Abrahamson accused the majority of reaching a hasty decision that’s "light on legal analysis," opening them up to the unnecessary charge that they “reached a pre-determined conclusion not based on the facts and the law, which undermines the majority's ultimate decision.” She believed the case should have followed the normal appeal route rather than the court taking original jurisdiction and issuing a decision that gives the case “short shrift.” “In rendering a decision, a court is to provide not merely an answer but also a reasoned, accurate explanation,” Abrahamson wrote. “A reasoned, accurate explanation is not an inconsequential nicety that this court may disregard for the sake of convenience or haste. It is the cornerstone of the legitimacy of judicial decision-making.” Credibility at Stake. The Court swooped in and issued an opinion on the eve of the Assembly debate, instead of letting the legislature "redo" the process of implementing a bill, damaging both the credibility of the court and legal precedent in the state of Wisconsin. At issue in front of the Supreme Court was the way in which Act 10 was forced through the legislature, subverting open meeting rules and access to the process, not the substantive content of the bill. The Republican led legislature had already drafted amendments to the budget to include Act 10 as an element of the state budget, thus going through the motions to "properly" pass the bill. Whether you disagree with the content of the bill or not, at issue is the process. The Supreme Court still intervened, instead of letting the legislature fix its own processes. As of the time this newsletter was published, a coalition of unions that represent public employees filed a federal lawsuit challenging the collective bargaining changes on the grounds that they violate the U.S. Constitution.Still Unclear. What is unclear is how Act 10 and the new budget will fit together. In fact, elements of the budget bill revise, clarify or conflict with Act 10, such as the new budget's passive review grants to DHS to subvert normal rulemaking processes. We will know more after the final version of the budget emerges.

More on the Budget: Things to Watch

In addition to the unspecified "cuts to Medicaid and BadgerCare programs" and the authority granted to DHS to change rules and laws without scrutiny, HealthWatch is following additional items in the budget that impact the care and coverage of our residents. Below are a few more:

Family Care: Joint Finance passed a motion prohibiting DHS from enrolling more people in Family Care. The motion states that no more people can be enrolled into Family Care, Family Care Partnership, PACE or IRIS programs than the total number of persons participating in all of those programs in that ADRC region.

Income Maintenance Centralization. In an audit letter released June 2, the Legislative Audit Bureau expressed grave concerns about the Department of Health Service’s Enrollment Services Center, the agency charged with enrolling childless adults in the limited BadgerCare Plus Core Plan and FoodShare programs. The Audit was released on the eve of the Joint Finance Committee addressing Budget Paper 355, the Centralization of Income Maintenance. The bitter taste the audit left in legislators’ mouths may help explain why Joint Finance opted for a compromise position, establishing a partnership between the state and counties to administer the income maintenance program instead of the more centralized approach Walker recommended. Now, little is known on how the "compromise" solution will work. The plan is to require all counties other than Milwaukee County to organize into no more than 10 multi-county consortia no later than Oct. 1 to administer BadgerCare/Medicaid programs.

Family Planning. The Joint Finance Committee voted to remove men from BadgerCare Plus-Family Planning Only services. It also included provisions that require parental consent for all patients under 18 years old, reduce the eligibility limit down to 200 percent of the federal poverty line and cut more than $1 million dollars in state funds to Planned Parenthood. Dropping men from the family planning services would require the approval of the federal government. Those watching the budget process are concerned that making this change without federal approval may jeopardize federal funding.

How High (or Low) is Too High for Health Insurance Costs

A June 8 article appearing in the Milwauke Journal Sentinal ran the headline "Area health insurance costs remain higher than Midwest average." HealthWatch Wisconsin will be digging into this issue in more detail over the coming weeks, looking at the elements of insurance costs from the creation of insurance rates, rate increases, and rate review. Behind the numbers the insurance companies are posting, are conflicting factors, increasing medical costs, fragmented individual markets--and the drastic lack of risk pooling, and inflated cost projections. Add to these, low medical loss ratios along with adverse selection and lax oversight, all issues the Affordable Care Act is trying to change. Stay tuned to future editions of the Update, the HealthWatch Reporter and HealthWatch WatchDog to learn about Wisconsin's rate review, medical loss ratio, and the federal grant Wisconsin's Commissioner of Insurance received to improve both of these. We'll check on their progress and suggest new strategies for Wisconsin.